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Jan 1'7 02 Ob: 38p HI �erkn&Chrzst -tJ Atli: -6U0 Imo. 1 <br /> 01/15/2002 14:42 464013E ENVIR]HMENTAL HEALTH PAGE 91 <br /> SAN JOAQUIN COUNTYPUBILIC HEALTH SERVICES WDyOGN+1m8Ep <br /> 735- ENVIRONMENTAL kAI_TH DIVISION <br /> 304 EASTWEBER AVENUE,THIRD FLOOR <br /> STOCKTON GA 95202 <br /> (209) 468.3420 t�i��' C p1 r qC&._7q3 3 <br /> PUBLIC RECORDS REL RASE APPLICATION <br /> APPLICANT O 'f 5O 10 fir BUSINESS/AGENCY �✓L S <br /> ADDRESSr � ,1 •SSrC/l Ave. sad !ca uc <br /> PHONE q1:o 7 70 FACSIMILE (S WL - 6 7 7 j <br /> TENTATIVE`APPOINTMENT DATE TiME <br /> (Please give 7 to 10 bubusiness days frorn date of application submittal) <br /> �-Wl 7- <br /> 13 CHECK BOX TO EXPEDITE REQUI±ST-$0.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USI:ONLY <br /> PROGRAM ELEMENTS SE;ARCH <br /> '3 5 ere,If ee Lars e I <br /> La /! 02 k- <br /> Ctr�{.,tce,� LAG Loaf3S <br /> ��75 L- I r✓a s coe^ 3S /S <br /> . � 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILE=S <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ ,HOUSING ABATFtMI;iaT ❑ SOLID WASTE FACILITY <br /> a OTHER CLEANUP SITE(NON-LOP) CI FOOD FACILITY O SOLID WASTE VEHIC_I= <br /> UND911GROUND YANK(MONITORINGIKEMOVAL) Q DOG KENNEL a DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PUNT <br /> C3 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL Q PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOOIBODY PEIRCING ❑ POOLlSPA ❑ LAND USE APPLICAT ON 5l FES ' <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 4 OTHER(PLEASE SPI:-IFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list abc ve by checking <br /> the appropriate box(es). At least one file type MUST"be selected. Fax to (209)464-01131; or mail to the <br /> address indicalad above, <br /> 2. EHD Will notify the applicant if any EHD files exist An appointment for review will be c anfirtned <br /> approximately five business days but no later than On(10) days after receipt of applict ton. The files <br /> will be held for a maximum of five business days fob review. Appointments should be vcheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> appllcation may by submitted when the file is availa�SIQ. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD stall at the expense <br /> of the applicant. Future fife reviews by the same applicant may require a$89.00 deposir prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff, <br /> 6. Applications rccelved after 3:00 pm will be processed the naxt business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PttONE FAX INITIALS <br /> REVIEWED YES NO EVIEW DATE <br />